- Holly Hill, Florida, United States
- Hybrid
- Full-time · Associate
- 3+ years
The Participant Benefits Specialist is responsible for managing and maintaining participant Medicaid and Medicare eligibility, ensuring accurate documentation, compliance, and timely renewals across multiple states.
Responsibilities
- Assist participants and caregivers with Medicaid and Medicare applications, renewals, appeals and eligibility updates
- Navigate state-specific systems to ensure timely and accurate benefit qualification for PACE program
- Maintain and update Medicaid renewal trackers, Medicare trackers, presumptive eligibility and termination logs monthly
- Conduct weekly reviews in Medicaid and Medicare portals or reports to identify new terminations and verify all active participants reflect PACE coverage
- Coordinate with Social Workers on necessary spenddowns for renewals and communicate updates to the team
Requirements
- High school diploma
- Associates or Bachelor’s degree in Human Services, Business, or a related field preferred
- Nice to have: State systems navigation
- Nice to have: IVF processes
- Nice to have: EDV processes